| NPI | 1356645550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60087603) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 023302) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2011-01-03 |